Invoice Surgeon in South Africa Cape Town –Free Word Template Download with AI
Consultant General & Laparoscopic Surgeon
Medical Council of South Africa (HPCSA) Reg: 0428912
Suite 402, Groote Schuur Private Hospital
Observatory, Cape Town, 7925
Western Cape, South Africa
Email: [email protected] | Tel: +27 (0)21 404 5000
Invoice Number: INV-CT-2023-8942
Date Issued: 24 October 2023
Due Date: 24 November 2023
Bill To:
Mr. James O'Connell
12 Kloof Street
Gardens, Cape Town, 8001
Western Cape, South Africa
Medical Aid: Discovery Health
Member Number: 8842-1920-00
Dependent Number: 01
Procedure Details:
Date of Surgery: 15 October 2023
Facility: Groote Schuur Hospital, Cape Town
Procedure: Laparoscopic Cholecystectomy
ICD-10 Code: K80.20
Medi-Save Code: 03100000
| Description of Services | Code | Quantity | Unit Price (ZAR) | Total (ZAR) |
|---|---|---|---|---|
| Consultation and pre-operative assessment in Cape Town clinic | 001 | 1 | 1,500.00 | 1,500.00 |
| Laparoscopic Cholecystectomy (Surgeon's Fee) | 03100000 | 1 | 18,500.00 | 18,500.00 |
| Post-operative follow-up consultation | 002 | 1 | 1,200.00 | 1,200.00 |
| Pathology referral fee (Gallbladder tissue analysis) | 003 | 1 | 2,500.00 | 2,500.00 |
| Medical report for Medical Aid claim submission | 004 | 1 | 850.00 | 850.00 |
Important Notes & Payment Instructions
This invoice represents the professional fees charged by the Surgeon for services rendered in Cape Town, South Africa. Please note that this invoice does not include hospital accommodation, theatre fees, anaesthetist fees, or nursing costs, which are billed separately by the healthcare facility.
Payment Terms: Payment is due within 30 days of the invoice date. Late payments may incur interest at the prevailing prime rate plus 2% per month.
Banking Details:
Bank: First National Bank
Account Name: Dr. A. van der Merwe Surgical Practice
Account Number: 6204 555 7890
Branch Code: 250655
Reference: INV-CT-2023-8942
Medical Aid Claims: If you are claiming through a South African medical aid scheme, please ensure that all necessary pre-authorizations were obtained prior to the procedure. This invoice is compliant with the National Health Act and HPCSA guidelines for billing in the Western Cape.
Authorized by:
Dr. A. van der Merwe
Consultant Surgeon
Received by:
__________________________
Date: ____________________
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